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UnitedHealthcare Community Plan Massachusetts Providers

You don't have time to spare:that's why we put all the documents you need in one place.Use the navigation items on the left to find what you're looking for fast.


To report health care Fraud, Waste and Abuse, contact us at 844-359-7736 or


Provider Training Materials

Medicaid Managed Care Rule External FAQs (PDF 64.57 KB)

Medicaid Managed Care Rule Presentation (PDF 90.71 KB)


HIPAA Claim Edits

UnitedHealthcare applies HIPAA edits to professional (837p) and Institutional (837i) claims submitted electronically.Visit the EDI Claim Edits page for more information including a complete list of edits, edits related to ICD-10 codes and applicable payers.Claims that reject for HIPAA edits will appear on a clearinghouse level report, enabling you to Identify and correct rejected Information prior to UnitedHealthcare receiving the claim.



UnitedHealthcare Community Plan Medical & Drug Policies and Coverage Determination Guidelines

UnitedHealthcare has developed Medical Policies, Medical Benefit Drug Policies and Coverage Determination Guidelines to assist us in administering health benefits.這些政策與準則僅供參考,不構成醫療建議。
View the guidelines

UnitedHealthcare Medicare Advantage Coverage Summaries

For policy guidance for Medicare Advantage plan members, view the UnitedHealthcare Medicare Advantage Coverage Summaries Manual and corresponding policy update bulletins here


UnitedHealth Group 要求遵守聯邦法與州法的規定,禁止提交與包括 Medicare 與 Medicaid 等聯邦醫療保健計劃相關的不實索賠。
View our policy (PDF 38.15 KB).


If UHG policies conflict with provisions of a state contract or with state or federal law, the contractual / statutory / regulatory provisions shall prevail.欲查看更新後的政策變更,請選擇左方的公告欄部份。